Where the reforms did not reach: doctors as front line managers

Abstract

The importance of the behavioral dimension of the management of front line teams in the health service has been neglected both in the training of doctors and in the recent reforms of the health service. Drawing on three case studies carried out by doctors, explores the influence of the level of understanding of behavioral factors in determining the effectiveness or ineffectiveness of management at this level. Concludes by considering some implications of the discussion for giving a more central place to these factors in the selection, training and promotion of doctors.

Decisions, decisions

“…Structure should not be allowed to hinder effective decision making; indeed Peters and Waterman have shown that the excellent companies have a very fluid structure[8]. The NHS has a strong and identifiable culture, but Hadley and Forster have pointed out that there is a “dearth of behavioural research in the contemporary NHS, as opposed to the early NHS”[16]. Patients and staff tend to have a fierce loyalty to the NHS concept, and change creates a “them and us” situation where doctors are perceived as protecting the ideal, managers dismantling it.…”

Management education for undergraduate doctors: A survey of medical schools

“…This must be placed within the context of the introduction of a problembased learning approach by a number of medical schools (Lowry, 1992a;1992b;1992c;1992d;Moore, 1996). This may particularly lend itself to the case study Journal of Management in Medicine 11,6 336 approach so often used in management teaching although the need for a theoretical underpinning should not be underestimated (Hadley and Forster, 1995).…”

“…while other aspects of management education and development including teamworking and leadership skills have also been advocated as necessary attributes of the independent practitioner (Hadley and Forster, 1995).…”